- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $4,265.80 / $7,943.28
| Facility | | $501.19 | $4,265.80 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $457.09 / $1,288.25
| Professional | | $199.53 | $457.09 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $199.53 / $457.09 / $1,380.38
| Professional | 52 | $199.53 | $457.09 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $199.53 / $588.84
| Professional | 53 | $63.10 | $199.53 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $2,290.87
| Facility | | $1,096.48 | $1,096.48 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $501.19 / $1,047.13
| Professional | | $263.03 | $501.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $512.86 / $1,148.15
| Professional | | $338.84 | $512.86 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $524.81 / $2,951.21
| Facility | | $234.42 | $524.81 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $602.56 / $1,071.52
| Professional | | $316.23 | $602.56 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $169.82 / $223.87 / $1,318.26
| Professional | 52 | $169.82 | $223.87 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- 53
- Typical Low / Median / Typical High
- $63.10 / $131.83 / $588.84
| Professional | 53 | $63.10 | $131.83 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $812.83 / $870.96
| Facility | | $489.78 | $812.83 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $478.63 / $977.24
| Facility | | $199.53 | $478.63 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $524.81 / $1,096.48
| Professional | | $87.10 | $524.81 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,715.35 / $4,677.35
| Facility | | $2,818.38 | $3,715.35 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $707.95 / $1,148.15
| Professional | | $380.19 | $707.95 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,548.82 / $4,168.69 / $5,888.44
| Facility | | $1,548.82 | $4,168.69 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $562.34 / $1,096.48
| Professional | | $309.03 | $562.34 | $1,096.48 |